Diffuse alveolar hemorrhage: Difference between revisions
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==Background== | |||
* Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition. | * Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition. | ||
* It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature. | * It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature. | ||
* Most commonly the result of systemic vasculitis. <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | * Most commonly the result of systemic vasculitis. <ref>Park M. Diffuse Alveolar Hemorrhage. Tuberc Resp Dis (Seoul) 2013. 74(4):151-162</ref> | ||
==Clinical Features== | |||
* [[Hemoptysis]] ( may be initially absent in up 33% of DAH presentations <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref> | * [[Hemoptysis]] ( may be initially absent in up 33% of DAH presentations <ref>Lara A, Schwarz M. Diffuse Alveolar Hemorrhage. Chest 2010. 137(5):1164-1171</ref> | ||
* [[Anemia]] | * [[Anemia]] | ||
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* Acute hypoxemic respiratory failure | * Acute hypoxemic respiratory failure | ||
==Differential Diagnosis== | |||
Idiopathic small vessel vasculitis | Idiopathic small vessel vasculitis | ||
* [[Wegener's granulomatosis]] | * [[Wegener's granulomatosis]] | ||
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[[Mitral stenosis]] | [[Mitral stenosis]] | ||
==Diagnosis== | |||
# Clinical suspicion with falling hematocrit | # Clinical suspicion with falling hematocrit | ||
# Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse | # Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse | ||
# Bronchoscopy with BAL showing sequentially increasing RBC counts | # Bronchoscopy with BAL showing sequentially increasing RBC counts | ||
==Management== | |||
General principles | General principles | ||
* Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | * Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable) | ||
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* [[Hemoptysis|Management of Hemoptysis]] | * [[Hemoptysis|Management of Hemoptysis]] | ||
=== | ==Disposition== | ||
==See Also== | |||
==References== | |||
<references/> | |||
Revision as of 19:51, 13 June 2016
Background
- Diffuse Alveolar Hemorrhage (DAH) is a life-threatening condition.
- It is a subset of Pulmonary hemorrhage involving the microcirculation involving alveolar microvasculature.
- Most commonly the result of systemic vasculitis. [1]
Clinical Features
- Hemoptysis ( may be initially absent in up 33% of DAH presentations [2]
- Anemia
- Diffuse lung infiltrates
- Acute hypoxemic respiratory failure
Differential Diagnosis
Idiopathic small vessel vasculitis
- Wegener's granulomatosis
- Churg-Straus syndrome
- Microscopic polyangitis
Primary immune complex-mediated vasculitis
- Goodpasture's syndrome
- Henoch-Schonlein purpura
Secondary vasculitis
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Mixed connective tissue disease
- Polymyositis/Dermatomyositis
Acute lung transplant rejection
Drug induced (ie. chemotherapy, amiodarone, propylthiouracil)
Multilobar Pneumonia
Pulmonic veno-occlusive disease
Diagnosis
- Clinical suspicion with falling hematocrit
- Radiographic imaging consistent with bilateral infiltration (CXR, CT) - can be patchy, focal or diffuse
- Bronchoscopy with BAL showing sequentially increasing RBC counts
Management
General principles
- Airway stabilization if large volume hemoptysis or problems with oxygenation/ventilation (>8.0 ETT preferable)
- IV corticosteroids - high dose Methylprednisolone Q6H[3]
- Bronchoscopy to obtain BAL and localize source of bleeding if localizable
- Management of Hemoptysis